WASHINGTON — For servicemembers and veterans suffering from PTSD, support is as close as their smartphone.
Thanks to a free mobile application known as PE Coach, available on Apple and Android devices, it is now possible for military and veteran patients to use their phones as a tool to support their Prolonged Exposure sessions.
That is only one of the types of mobile apps for behavioral-health treatment that can help healthcare providers assist their patients.
“With new technological developments occurring every day, healthcare providers are in a unique position to interact with patients using different modalities, such as mobile phones, websites and tablets that we could not have imagined 20, 10 or even five years ago,” Col. Rick Campise, deputy director for the National Capital Region National Center for Telehealth and Technology (T2), Joint Base Lewis-McChord, WA, said during a recent DCoE webinar.
T2 was established in 2008 to lead DoD’s efforts to advance the use of technology for prevention and treatment of a broad range of health conditions.
Julie Kinn, deputy director for T2’s Mobile Health Program, said that, when it comes to behavioral health, Web and mobile applications offer many benefits.
For example, because troops and their families are comfortable using smartphones, accessing behavioral health content on apps might be less intimidating than accessing the content through other venues.
“The mobile apps are stigma-reducing, because the platform/interface is so familiar to servicemembers,” Kinn explained.
Mobile apps also are suited for military health promotion because of the sheer number of troops with smartphones.
“Data do vary on our U.S. military, but one study indicated that 73% of active duty servicemembers have smartphones,” she said.
Moreover, Kinn said that studies indicate that 70% of people sleep with their cellphones.
“It makes sense that we would want to make applications that can be acceptable at any time. So, for example, if they wake up in the middle of the night with a sleep problem, they probably have their cellphone right there, and we can assume that it would be easy for them to access an app.”
Still, Kinn said there is both good news and bad news when it comes to app development. That bad news is that there is currently a dearth of outcomes research about specific mobile apps promoting health. Another challenge is that there is tension between producing these apps quickly and thoroughly testing them.
“At T2, we don’t put out any technology that is not evidence based; everything we have is based on established clinical practice, and then we do outcomes research. But, depending on the need, we do determine different ways to release it whether or not to test thoroughly in [a randomized controlled trial] first or to put it on the street first.”
Another challenge is that there is no central review process for public-facing applications, she said.
“The Military Health System and DoD don’t have a warehouse for all the apps to go through to make sure they are good or doing what they need to do before they go out to servicemembers or civilians,” she said.
On the positive side, most government apps and all apps put out by T2 are based on evidence-based practices, she said. In addition, research is in progress and user data is promising.
“When we look at apps we want to see when users download them, do they download it and then use it once or twice and never use it again? Or, do they download it and then have multiple sessions? So far, we are seeing for our apps users download these in great numbers, and then they actually use them several times,” she said.
The PE Coach is one of the products developed by T2 in partnership with VA’s National Center for PTSD and DoD’s Center for Deployment Psychology. It is the first mobile app designed to support the tasks associated with PE treatment for PTSD, according to T2.
Patients undergoing PE treatment work with a therapist to deal with trauma-related situations and memories. PE therapy sessions involve meetings, typically around 90 minutes, with therapists about eight to 15 sessions. Therapy sessions typically last 90 minutes.
“Exposure therapy is found to be an effective treatment, regardless of who is found to review the scientific literature,” Greg Reger, a licensed clinical psychologist at T2, said during a presentation.
Reger said that in the past there have been barriers to the use of PE, including the need for the provider to record the sessions to give to the patient to listen to outside the sessions and the fact that homework assignments can take up to two hours a day.
“We know homework compliance can predict treatment outcomes,” he said.
Reger said the app provides support by providing an easy way for patients to record the sessions and to do their homework assignments directly onto their phones.
“Anything we can do to support our providers delivering the treatments that work to our patients who need them are welcome changes,” he said.
Another app that providers and troops and veterans might find helpful is the T2 Mood Tracker, which is a self-monitoring program that allows users to rate their moods and symptoms over a period of time using a visual analogue rating scale. Users can monitor emotional experiences associated with behavioral-health issues such as PTSD, brain injury, life stress, depression and anxiety.
“What is nice about it is that it allows patients to check in on their moods any time of day, first thing in the morning and last thing at night,” Kinn said. “It is a lot easier than carrying a big piece of paper that their therapist has given them.”